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Co-Occurring Alcohol Use Disorder and Anxiety: Bridging the Psychiatric, Psychological, and Neurobiological Perspectives

“Those who cannot remember the past are condemned to repeat it.”

—George Santayana

Few observations in psychiatry have been documented as long and as consistently as the association between anxiety (and general negative affect) and the chronic misuse of alcohol. Research has shown that up to 50% of individuals receiving treatment for problematic alcohol use also met diagnostic criteria for one...

Anxiety and Alcohol Use Disorders: Comorbidity and Treatment Considerations

Co-occurring anxiety disorders and alcohol use disorders (AUDs) are of great interest to researchers and clinicians. Cumulative evidence from epidemiological and clinical studies over the past few decades has highlighted both the frequency and clinical impact of this comorbidity. Investigations into the unique connections between specific anxiety disorders and AUDs have shown that this association...

Alcohol’s Negative Emotional Side: The Role of Stress Neurobiology in Alcohol Use Disorder

Introduction

The word “alcohol” often conjures up positive feelings and associations with fun, socializing, relaxing, and partying. Yet there is another side to drinking alcohol, especially with risky, hazardous levels of consumption. This side is associated with distress and may include anxiety, loneliness, pain, and depressive symptoms.1 This has been labeled the “dark side,” or “negative...

Common Biological Mechanisms of Alcohol Use Disorder and Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly comorbid. Although recent clinical studies provide some understanding of biological and subsequent behavioral changes that define each of these disorders, the neurobiological basis of interactions between PTSD and AUD has not been well-understood. In this review, we summarize the relevant animal models that parallel...

Resilience to Meet the Challenge of Addiction: Psychobiology and Clinical Considerations

Evidence from different disciplines suggests that acute and chronic stress–related mechanisms play an important role in both the development and the chronic, relapsing nature of addiction (Baumeister 2003; Baumeister et al. 1994; Brady and Sinha 2005). Stress is defined as the physiological and psychological process resulting from a challenge to homeostasis by any real or perceived demand on the...

Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain

Introduction

Pain is a complex, near-universal phenomenon, which can be conceptualized as a motivational state that engenders goal-directed action.1 Motivational models of substance use highlight the role of expected effects and suggest that individuals become motivated to use substances when such use is perceived as holding greater value than other available objects or events.2,3 A rapidly...

Integrating Treatment for Co-Occurring Mental Health Conditions

Given the high co-occurrence between alcohol use disorder (AUD) and mental health conditions (MHCs), and the increased morbidity associated with the presence of co-occurring disorders, it is important that co-occurring disorders be identified and both disorders addressed in integrated treatment. Tremendous heterogeneity exists among individuals with co-occurring conditions, and factors related to...

Stress, Epigenetics, and Alcoholism

Alcoholism is a complex disorder characterized by compulsive alcohol seeking and consumption that also is impacted by related psychiatric states, such as anxiety (Koob 2003; Pandey 2003). Both environmental and genetic factors influence alcohol drinking patterns and may increase susceptibility to the development of alcohol addiction (Cloninger 1987; Crabbe 2002). The presence or development of...

How Does Stress Lead to Risk of Alcohol Relapse?

It has long been known that stress increases the risk of alcohol relapse (Sinha 2001). Clinical observations, surveys, and epidemiological studies document an association between self-reports of stressors and subsequent return to drinking. Studies assessing alcohol relapse after treatment completion and discharge also indicate the contribution of highly stressful events independent of alcohol use...